Pharmacogenomics and Personalized Medicine: A Comprehensive Review of Clinical Implementation, Genetic Determinants, and Future Frontiers

Abstract

Pharmacogenomics (PGx), the convergence of pharmacology and genomics, has evolved from a theoretical discipline into a cornerstone of precision medicine. By elucidating the genetic basis for interindividual variability in drug response, PGx aims to maximize therapeutic efficacy while minimizing adverse drug reactions (ADRs). This comprehensive research paper provides an exhaustive analysis of the current state of pharmacogenomics as of late 2025. It synthesizes data regarding key drug-gene interactions—specifically involving CYP2C19, CYP2D6, CYP2C9, VKORC1, DPYD, HLA-B, and SLCO1B1—and examines the
evolution of clinical guidelines from the Clinical Pharmacogenetics Implementation Consortium (CPIC) and other regulatory bodies. Furthermore, this report critically evaluates the integration of Artificial Intelligence (AI) in predictive toxicology and dosing algorithms, assesses the barriers to clinical implementation, and provides a forward-looking perspective on the field's trajectory. The analysis highlights pivotal 2025 updates regarding statin safety and SLCO1B1 allele reclassification, marking a significant refinement in cardiovascular precision medicine. The review also incorporates data from recent pilot implementation studies and regulatory updates from the FDA and NCCN concerning fluoropyrimidine toxicity.